DOCSLIB.ORG

Fuchs' Heterochromic Uveitis: a Reappraisal of the Clinical Spectrum

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fuchs' Heterochromic Uveitis: a Reappraisal of the Clinical Spectrum Eye (1991) S, 64 9-661 Fuchs' Heterochromic Uveitis: A Reappraisal of the Clinical Spectrum NICHOLAS P. JONES Manchester Summary The varying clinical appearance within a group of 103 patients with Fuchs' Hetero­ chromic Uveitis (FHU) is discussed. Bilateral cases accounted for 7.8% of patients. Cataract was found in 80.2% of cases after 8.8 years mean follow-up, and glaucoma affected 26.2% of patients. The most important diagnostic criteria are the typical pattern of iris atrophy and depigmentation, the characteristic intraocular inflam­ mation, and complicated cataract. These are described in detail. The correct diag­ nosis of FHU is important because it affects future management and prognosis. The presence or absence of macroscopic heterochromia is not a helpful component of the ocular examination and should play little part in diagnosis. FHU does not necessarily present in its classical form, and may first resemble acute anterior uveitis or pars planitis. The syndrome may be the end stage of a number of different conditions. Although the combination of heterochromia tis (FHU) has placed into perspective some of and cataract was noted in 1843 by Lawrence, I the accepted criteria for diagnosis, has and later by others2,3 it was not until 1906 that allowed further comment on some aspects of Ernst Fuchs comprehensively described a previous reports, and has brought to light group of 38 patients with signs of a form of some features not previously discussed in heterochromia with inflammation and catar­ detaiL The clinical spectrum of FHU is wider act, dubbed 'complicated heterochromia',4 than has been previously defined, and the The syndrome which now bears his name has clinical course is more variable, Studies on a interested many authors in the succeeding 85 cohort of 103 patients with FHU are reported. years and some series of considerable size have been published,5-8, The classical diag­ nostic criteria for the condition were reiter­ Patients and Methods ated in 1955 by Franceschetti5 and include the Commencing in 1987, all new and old patients presence of stellate keratic precipitates, a seen at the Manchester Royal Eye Hospital characteristic pattern of iris atrophy, with or with a definiteor suggested diagnosis of FHU, without nodules (and without posterior syn­ were referred to and examined by the author, echiae), vitreous opacification, cataract and In all cases a detailed history was taken, possibly glaucoma, A comprehensive review9,10 including mode of, and reason for, presen­ of the literature was published in 1973. tation, General medical, neonatal, gesta­ The critical examination of a large number tional and family histories were included. The of patients with Fuchs' Heterochromic Uvei- clinical course of the disease process was Correspondence to: Mr. N. P. Jones, FRCS, FCOphth, University Department of Ophthalmology, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH. 650 N. P. JONES noted, including a record of medical and sur­ distinct groups; fifteen patientshad congeni­ gical management. tal heterochromia and 25 had noticed a later A full clinical examination included onset. The age at which the heterochromia appraisal of facial appearance, slit-lamp bio­ was firstnoticed, for the 25 patients in which it microscopy including a critical examination of was not congenital, is shown in Fig. 2). cornea, anterior chamber and iris, applana­ A previous ophthalmic history revealed tion, and dilatation for fundoscopy. Corneal that 16 patients (15.5%) had had poor vision endothelial specular microscopy and haemat­ in the affected eye since childhood, but none ological investigations were performed in had presented to an ophthalmologist at that selected cases. Most patients have been exam­ stage. A lower best visual acuity on the ined on several occasions by the author. A affectedside (in those with clear media and no total of 128 patients were referred with a defi­ macular disease) implied amblyopia. There nite or suggested diagnosis of FHU. Of these, was no history of strabismus in any of these 103 were considered to fulfil criteria for this patients. Only three patients had significant diagnosis and were included in the survey. anisometropia, the affected eye being more myopic in all three cases. No patient had evi­ Results dence of amblyopia in the eye without inflam­ The patients' ages at presentation are shown mation. Of these patients with amblyopia, graphically in Fig. 1. The range was 8 to 71 nine were aware of their heterochromia, and years, with a mean of 36. 1 years. The major in four cases it was definitelyacquired, at ages symptoms at presentation are shown in 17, 21, 35 and 38 years, respectively. Two Table 1. The follow-up since presentation has patients remembered a blunt anjury of some a range of six months to 59 years, with a mean significance to the involved eye at some time of 8.8 years. Fifty patients (48.5%) were male previously. Nineteen patients complained of and 53 (51.5%) female. Ninety-five patients eye or brow ache before or since presentation. (92.2%) were Caucasian, three Asian and five Three patients were aware of a significant Afro-caribbean or mixed race (total 7.8% maternal illness during pregnancy. One non-Caucasian). The precise catchment mother had serum hepatitis, one had epileptic population of this hospital cannot be defined, fits (the reason being unknown), and another but the racial balance of these patients prob­ required transfusion. Ninety-eight patients ably does not indicate any racial predilection were delivered vaginally at term without inci­ for the disease. dent. Five patients were delivered with The diagnosis of FHU was not always made forceps, of whom one was known to have sus­ immediately on presentation. The delay in tained an ocular injury, and one claimed to diagnosis ranged from 0 to 57 years, with a have been injured. The only significant prob­ mean of 3.4 years. Table II shows the diag­ lem in the neonatal period involved one noses made on presentation. patient with a ventricular septal defect which The degree of heterochromia was graded required closure. 0-4 by the author. Heterochromia was absent In no patient in this series was evidence (Grade 0) in 10 patients, of whom eight found of a positive familial association for (7.8%) had bilateral disease and two had dark FHU or any other variety of heterochromia. brown irides. Heterochromia Grade 1-4 was On the contrary, discordance in a pair of present in the remaining 93 patients (90.3%) monozygotic twins has been discovered. The but was extremely subtle (Grade 1) in 42 implications of this on any genetic theory for cases, though usually still apparent with the FHU are discussed elsewhere. II naked eye. In a small number of patients, het­ Enquiries into the general health of these erochromia could only be definedby compari­ patients revealed the following; three patients son of anterior segment photographs. have peptic ulceration, two systemic hyper­ Of those patients with heterochromia, 40 tension, and one each have Addison's (43.0% ) were already aware of this fact. All of disease, hypernephroma, diabetes, epilepsy, these patients knew the time of onset of their pernicious anaemia, Parkinsonism, ischaemic heterochromia, and appeared to fall into two heart disease, discoid lupus erythematosus, FUCHS' HETEROCHROMIC UVEITIS: A REAPPRAISAL OF THE CLINICAL SPECTRUM 651 2 NUMBER OF PATIENTS acellular on specular microscopy, and one cor­ 0 nea showed linear marks in Descemet's mem­ brane typical of previous trauma and r- 5 consistent with a history of forceps damage ,- � during delivery. c- Keratic precipitates (KP) were present in 0 o- 93 eyes (83.8%). The distribution of precip­ r- � itates was variable, yet seemed to fitinto three r 1 broad patterns (Fig. 3); generalised, affecting the whole posterior cornea (57 eyes); central nn I In II 1-1'1 (16 eyes); and inferior (20 eyes), often dif­ -5 -10 -15 -20 -25 -30 -35 -40 -45 -50 -55 -60 -65 -70 -75 fusely so but occasionally in a triangular distri­ AGE AT PRESENTATION bution more commonly associated with acute Fig. 1. The age range of patients with FHU at first presentation to an ophthalmologist. anterior uveitis. The morphology of KP was variable, but many eyes (45, 40.5%) showed previous tuberculosis, and Factor VII defi­ precipitates previously described as typical of ciency. One patient is a haemophilia carrier. FHU,5.12 that is, stellate with fibrillary exten­ On examination, the right eye was affected sions, and tiny interspersed fibrils. A dia­ in 50 cases (48.5%) and the left in 45 (43.6%), grammatic example of a typical area of such the remaining eight patients being bilateral. keratic precipitates is shown in Fig. 4. Nine­ Head or facial appearance was notable in only teen eyes (17. 1%) had KP which are two cases, both of whom were affected by the described as 'glassy', being medium-sized, Parry-Romberg syndrome of hemifacial atro­ globular, transparent and non-pigmented. phy on the affected side. Ten patients had a Old pigmented KP were seen in five eyes. partial ptosis on the affected side, of whom There was some correlation between mor­ eight had undergone cataract surgery. No phology of KP and their distribution. Typi­ patient in this series had acceptable evidence cally stellate KP were centrally or generally distributed (38 of 45 eyes, 84.4%). Only seven of Homer's syndrome. The cornea of the affec ed eye, examined of 20 eyes (35%) with inferiorly-distributed . � with the slit-lamp biomicroscope, was KP showed stellate characteristics. Anterior chamber activity was recorded abnormal in 17 eyes (15.3%) of whom eight + + +. had previously undergone cataract surgery. traditionally on a scale of 0 to Fifty­ nine eyes (53. 1 %) had no cellular activity and Three corneas were partially or completely (+).
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • The Official Scientific Journal of the Delhi Ophthalmologycal Society DJO Vol
    DJO Vol.20, No. 2, October-December 09 DJO Vol.20, No. 2, October-December 09 October-December 2, No. Vol.20, DJO The Official Scientific Journal of the Delhi Ophthalmologycal Society DJO Vol. 20, No. 2, October-December, 2009 Delhi Journal of Ophthalmology Editor Editorial Board Rohit Saxena Rajvardhan Azad Ramanjit Sihota Managing Editor Vimla Menon Divender Sood Rajesh Sinha Atul Kumar Rishi Mohan Ashok K Grover Namrata Sharma Editorial Committee Mahipal S Sachdev Tanuj Dada Parijat Chandra M.Vanathi Lalit Verma Rajinder K hanna Tushar Agarwal Prakash Chand Agarwal Sharad Lakhotia Harbans Lal Chandrashekhar Kumar Swati Phuljhele P V Chaddha Amit Khosla Shibal Bhartiya Reena Sharma Dinesh Talwar B Ghosh Munish Dhawan Twinkle Parmar K.P.S Malik Kirti Singh Harinder Sethi Varun Gogia Pradeep Sharma B P Guliani Raghav Gupta Sashwat Ray V P Gupta S P Garg Ashish Kakkar Saptrishi Majumdar S. Bharti Arun Baweja General Information Delhi Journal of Ophthalmology (DJO), once called Visiscan, is a quarterly journal brought out by the Delhi Opthalmological Society. The journal aims at providing a platform to its readers for free exchange of ideas and information in accordance with the rules laid out for such publication. The DJO aims to become an easily readable referenced journal which will provide the specialists with up to date data and the residents with articles providing expert opinions supported with references. Contribution Methodology Delhi Journal of Opthalmology (DJO) is a quarterly journal. Author/Authors must have made significant contribution in carrying out the work and it should be original. It should be accompanied by a letter of transmittal.
    [Show full text]
  • A Description of the Clinical Features of Brimonidine- Associated Uveitis Alyssa Louie Primary Care Resident, San Francisco VA
    Drug-induced intraocular inflammation: A description of the clinical features of brimonidine- associated uveitis Alyssa Louie Primary Care Resident, San Francisco VA Abstract: A description of the clinical features, diagnostic work-up, and management of acute anterior uveitis caused by brimonidine, a widely used glaucoma medication. I. Case History a. Patient demographics: 74 year-old white male b. Chief complaint: eye pain, redness, irritation for last 2 weeks c. Ocular and medical history: i. Ocular history 1. Primary open angle glaucoma OU, diagnosed 8 years ago 2. Senile cataracts OU, not visually significant 3. Type 2 Diabetes without retinopathy OU 4. No prior history of uveitis ii. Medical history: Diabetes Mellitus Type 2 iii. No known drug allergies d. Medications i. Ocular: dorzolamide BID OU (1.5 years), brimonidine BID OU (11 months), travatan QHS OU (5.5 years) ii. Medical: metformin 500mg tab BID PO II. Pertinent Findings a. Clinical exam i. Visual acuities: OD 20/20-, OS 20/20- ii. Goldmann applanation tonometry: 13 mm Hg OD, 13 mm Hg OS iii. Anterior segment 1. OU: 3+ diffuse conjunctival injection 2. OU: central and inferior granulomatous keratic precipitates 3. OU: Grade 1+ cell, 1+ flare 4. OU: No synechiae or iris changes were present iv. Posterior segment 1. Optic Nerve a. OD: Cup-to-disc ratio 0.70H/V, distinct margins b. OS: Cup-to-disc ratio 0.75H/V, distinct margins 2. Posterior pole, periphery, vitreous: unremarkable OU b. Laboratory Studies i. ACE, Lysozyme, FTA-ABS, VDRL, HLA-B27, Rheumatoid Factor, ANA, PPD, Chest X- ray: all negative/unreactive III.
    [Show full text]
  • Duane Retraction Syndrome
    Med. J. Cairo Univ., Vol. 78, No. 1, June: 331-336, 2010 www.medicaljournalofcairouniversity.com Duane Retraction Syndrome KARIMA L. SHALABY, M.D.* and MOSTAFA BAHGAT, M.D.** The Pediatric Ophthalmology Section*, Tripoli Eye Hospital and the Department of Ophthalmology**, Faculty of Medicine, Cairo University. Abstract Electromyography studies have shown paradox- ical innervations of Lateral rectus muscle and Purpose of Study: To evaluate and to manage if manage- anomalous synergistic innervations of medial rec- ment indicated for cases of Duane retraction syndrome. tus, inferior rectus, superior rectus and oblique Patients and Methods: 15 Duane retraction syndrome muscles [7,8] . (DRS) patients seen in Pediatric clinic in Tripoli Eye Hospital in period from January 2006-December 2006. Complete In most cases of DRS the entire 6 th nerve atro- ophthalmic examination including ortho-optic assessment for phy instead of post half of 6 th nerve (without all cases. specific teratogenic stimulus) 95% of DRS cases Results: Patients age ranged 1 year to 20 years in this this is the only initial abnormality. In about 5% of group of study, females were affected more than males with cases other abnormalities seen (e.g. nerve deafness). 2 to 1 ratio. Type 1 (esotropic) is the most common 80% of cases. Left eye was affected more than right eye. Bilateral in Most cases of DRS are sporadic [5,9] . 13.3% of cases. DRS clinical picture varies widely, surgical intervention will not eliminate the abnormality but will lessen Etiology: it. Two cases were operated upon to improve alignment in Etiology of DRS has been proposed by several primary position.
    [Show full text]
  • Reiter's Syndrome
    iMedPub JOURNALS ARCHIVES OF MEDICINE | 2009 | Vol. 1 | No. 1:1 | doi: 10.3823/032 Review Reiter's Syndrome Digna Llorente Molina, Susandra Cedeño Facultad de Ciencias Médicas 10 de Octubre. Ciudad Habana, Cuba. E-mail: [email protected] Reiter’s syndrome is a systemic disorder characterized by ocular conjunctivitis or uveitis, reactive arthritis, and urethritis manifestations. The exact cause of reactive arthritis is unknown. It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella or Yersinia. Certain genes may make you more prone to the syndrome. The diagnosis is based on symptoms. The goal of treatment is to relieve symptoms and treat any underlying infection. Reactive arthritis may go away in 3 - 4 months, but symptoms may return over a period of several years in up to a half of those affected. The condition may become chronic. Preventing sexually transmitted diseases and gastrointestinal infection may help prevent this disease. Wash your hands and surface areas thoroughly before and after preparing food. © Archives of Medicine: Accepted after external review ■ The first description of Reiter’s syndrome was attributed in occasionally, cutaneous-mucosal lesions such as keratodermia 1916 to the re-known German physician Hans Reiter, linked to blennorrhagica and balanitis circinata; yellow papule lesions Nazi powers, and to his experiments in the concentration on the soles, palms and with less frequency on the nails, camps. In 1918, Junghanns described the first case in a young scrotum, scalp and trunk, amongst others (3), (4), (5).. The patient (1), (2). earliest manifestation of joint disorder is entesitis, normally in the Achilles tendon and in the plantar fascia of the calcaneus, Due to the syndrome’s abnormal immunological reactivity to causing shortening or lengthening of fingers and toes certain pathogens as a result of the interaction between resembling "sausage fingers and toes".
    [Show full text]
  • The Uveo-Meningeal Syndromes
    ORIGINAL ARTICLE The Uveo-Meningeal Syndromes Paul W. Brazis, MD,* Michael Stewart, MD,* and Andrew G. Lee, MD† main clinical features being a meningitis or meningoenceph- Background: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. alitis associated with uveitis. The meningeal involvement is Review Summary: We review the clinical manifestations of uveitis often chronic and may cause cranial neuropathies, polyra- and describe the infectious, inflammatory, and neoplastic conditions diculopathies, and hydrocephalus. In this review we define associated with the uveo-meningeal syndrome. and describe the clinical manifestations of different types of Conclusions: Inflammatory or autoimmune diseases are probably uveitis and discuss the individual entities most often associ- the most common clinically recognized causes of true uveo-menin- ated with the uveo-meningeal syndrome. We review the geal syndromes. These entities often cause inflammation of various distinctive signs in specific causes for uveo-meningeal dis- tissues in the body, including ocular structures and the meninges (eg, ease and discuss our evaluation of these patients. Wegener granulomatosis, sarcoidosis, Behc¸et disease, Vogt-Koy- anagi-Harada syndrome, and acute posterior multifocal placoid pig- ment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a The uveo-meningeal syndromes are a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in heterogeneous group of disorders that share patients 40 years of age or older with bilateral uveitis, especially involvement of the uvea, retina, and meninges.
    [Show full text]
  • Management of Chronic Anterior Uveitis Relapses: Efficacy of Oral Phospholipidic Curcumin Treatment. Long-Term Follow-Up
    Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up Pia Allegri1 Abstract: Curcumin has been successfully applied to treat inflammatory conditions in Antonio Mastromarino1 experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy Piergiorgio Neri2 of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva) administered twice a day in recurrent anterior uveitis of different etiologies. The 1Uveitis Center, Ophthalmological Department of Lavagna Hospital, study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. Genova, Italy; 2Uveitis Unit, The We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune Eye Clinic, Azienda Ospedaliero- uveitis), group 2 (herpetic uveitis), and group 3 (different etiologies of uveitis). The primary Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy end point of our work was the evaluation of relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses in the three etiological groups. Wilcoxon signed-rank test showed a P , 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy.
    [Show full text]
  • UVEITIS Eye74 (1)
    UVEITIS Eye74 (1) Uveitis Last updated: May 9, 2019 Classification .................................................................................................................................... 1 Etiologic categories .......................................................................................................................... 2 Treatment ......................................................................................................................................... 2 Complications ................................................................................................................................... 2 COMMON UVEITIC SYNDROMES ............................................................................................................. 2 Masquerade Syndromes ................................................................................................................... 3 UVEITIS - heterogenous ocular diseases - inflammation of any component of uveal tract (iris, ciliary body, choroid). CLASSIFICATION ANTERIOR UVEITIS (most common uveitis) - localized to anterior segment - iritis and iridocyclitis. IRITIS - white cells confined solely to anterior chamber. IRIDOCYCLITIS - cellular activity also involves retrolental vitreous. etiology (most do not have underlying systemic disease): 1) idiopathic postviral syndrome (most commonly 38-60%) 2) HLA-B27 syndromes, many arthritic syndromes (≈ 17%) 3) trauma (5.7%) 4) herpes simplex, herpes zoster disease (1.9-12.4%) 5) iatrogenic (postoperative). tends to
    [Show full text]
  • Strabismus: a Decision Making Approach
    Strabismus A Decision Making Approach Gunter K. von Noorden, M.D. Eugene M. Helveston, M.D. Strabismus: A Decision Making Approach Gunter K. von Noorden, M.D. Emeritus Professor of Ophthalmology and Pediatrics Baylor College of Medicine Houston, Texas Eugene M. Helveston, M.D. Emeritus Professor of Ophthalmology Indiana University School of Medicine Indianapolis, Indiana Published originally in English under the title: Strabismus: A Decision Making Approach. By Gunter K. von Noorden and Eugene M. Helveston Published in 1994 by Mosby-Year Book, Inc., St. Louis, MO Copyright held by Gunter K. von Noorden and Eugene M. Helveston All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the authors. Copyright © 2010 Table of Contents Foreword Preface 1.01 Equipment for Examination of the Patient with Strabismus 1.02 History 1.03 Inspection of Patient 1.04 Sequence of Motility Examination 1.05 Does This Baby See? 1.06 Visual Acuity – Methods of Examination 1.07 Visual Acuity Testing in Infants 1.08 Primary versus Secondary Deviation 1.09 Evaluation of Monocular Movements – Ductions 1.10 Evaluation of Binocular Movements – Versions 1.11 Unilaterally Reduced Vision Associated with Orthotropia 1.12 Unilateral Decrease of Visual Acuity Associated with Heterotropia 1.13 Decentered Corneal Light Reflex 1.14 Strabismus – Generic Classification 1.15 Is Latent Strabismus
    [Show full text]
  • Clinical Practice Guidelines: Care of the Patient with Anterior Uveitis
    OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 32,000 full-time equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 7,000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Anterior Uveitis care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ANTERIOR UVEITIS Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Anterior Uveitis: Kevin L. Alexander, O.D., Ph.D., Principal Author Mitchell W. Dul, O.D., M.S. Peter A. Lalle, O.D. David E. Magnus, O.D. Bruce Onofrey, O.D. Reviewed by the AOA Clinical Guidelines Coordinating Committee: John F. Amos, O.D., M.S., Chair Kerry L. Beebe, O.D. Jerry Cavallerano, O.D., Ph.D. John Lahr, O.D.
    [Show full text]
  • Vogt-Koyanagi-Harada's Disease: Literature Review
    Artigo de Revisão Vogt-Koyanagi-Harada’s Disease: Literature Review Stephanie Gonçalves Carneiro*, Dorivaldo Lopes da Silva**, Angélica Cristina Pezzin Palheta***, Francisco Xavier Palheta Neto****, Cláudio Tobias Acatauassú Nunes*****, Thaís Oliveira Ferreira******, Talita Valleska de Campos Pereira******, Viviane Cristina dos Santos Monteiro******. * 5th year student of Medicine at Universidade do Estado do Pará (Monitor of Ophthalmology discipline). ** 5th year student of Medicine at Universidade do Estado do Pará (Monitor of Otorhinolaryngology discipline). *** Assistant teacher of ENT discipline at Universidade do Estado do Pará (Master degree in ENT by Universidade Federal do Rio de Janeiro – Doctorate student on Neuroscience by Universidade do Estado do Pará). **** Assistant teacher of ENT discipline at Universidade do Estado do Pará and Universidade Federal do Pará (Máster degree in ENT by Universidade Federal do Rio de Janeiro – Doctorate student on Neuroscience by Universidade do Estado do Pará). ***** Adjunt Professor and Head of ENT Discipline of Universidade do Estado do Pará. Visiting Professor of ENT at Universidade Federal do Pará. Master and PhD in ENT by UNIFESP). ****** Medical school student (3rd year) at Universidade do Estado do Pará. Institution: Universidade do Estado do Pará – UEPA (State Universtity). Belém / PA – Brazil. Mail address: Stephanie Gonçalves Carneiro – Travessa Rui Barbosa 619, Apto. 1301 – Belém / PA – Brazil – Zip code: 66053-260 – Telephone: (+55 91) 3242-7178 / 8123-1638 - E-mail: [email protected] Article received on December 1st, 2007. Article approved on March 16th, 2007. SUMMARY Introduction: Vogt-Koyanagi-Harada’s disease is a rare syndrome that affects tissues with melanocytes like eyes, central nervous system, skin and inner ear.
    [Show full text]
  • Vertical Rectus Transposition in Duane&Rsquo
    Eye (2015) 29, 839–842 & 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye Sir, 5 Souza-Dias C. Congenital VI nerve palsy is Duane syndrome CORRESPONDENCE Vertical rectus transposition in Duane’s syndrome: does until disproven. Binocul Vis Strabismus Q 1992; 7:70. co-contraction worsen? 6 Sharma P, Tomar R, Menon V, Saxena R, Sharma A. Evaluation of periosteal fixation of lateral rectus and partial 1 We read with interest the article by Akar et al. We would VRT for cases of exotropic Duane’s retraction syndrome. like to make the following observations/queries. Indian J Ophthalmol 2014; 62: 204–208. In patients with Duane’s retraction syndrome there is some degree of subnormal and some degree of V Bhambhwani, PK Pandey, S Sood and K Rana anomalous innervation of the lateral rectus (LR) muscle. The extent and severity of the two may be variable. Guru Nanak Eye Centre and Maulana Azad Medical Presumably, subnormal innervation may lead to deficient College, New Delhi, India abduction and anomalous innervation may lead to E-mail: [email protected] co-contraction with globe retraction, palpebral aperture narrowing, or retraction equivalents like upshoots and Eye (2015) 29, 839; doi:10.1038/eye.2014.309; downshoots. published online 6 February 2015 In their article the authors describe patients of type 1 Duane syndrome to be with esotropia of 20 pd or more, an AHP larger than 201, limited abduction, and no significant upshoots or downshoots in the adducted Sir, position. There is no objective grading used for the Reply: Vertical rectus transposition in Duane’s measurement of shoots or palpebral aperture changes.
    [Show full text]